Question

Barbara from North Carolina asks: I need pointers on the cancer patient for eating out in restaurants. Can you help me?

Answer

Diet modifications for cancer patients vary widely so it is impossible to answer this question in a way that it applies to all individuals with cancer. I can only provide examples to illustrate situations where restaurant eating can and cannot be helpful. The biggest advantage of restaurant eating is that it can provide a nourishing meal with little effort. "Cancer fatigue" often limits the energy to prepare meals. If family or friends cannot prepare meals, restaurants can provide a wide variety of foods. The chance of pace and getting out to see people also can help the spirit. If chemotherapy has changed the sense of smell or created aversions to certain smells, it is sometimes helpful to eat in restaurants so that smells are not lingering around the house from cooking. (although some restaurant smells may also be overwhelming to the person). If someone, however, is in the middle of a therapy that causes nausea and vomiting, they may find it uncomfortable to eat in a restaurant. Food choices at the restaurant depend on the person's individual situation and any special dietary needs. Sometimes during cancer therapy, the mouth, throat or esophagus may be irritated and the individual will prefer soft, non-spicy foods. This is easily accommodated in most restaurants, although in some ethnic restaurants, their interpretation of "not spicy" may still be too spicy for someone with a sore mouth. If an individual has a very small appetite, restaurant portions may be overwhelming. In this case, the person just needs reassurance that they can take home what they cannot finish. Leftovers may be great for an individual too tired to cook, but only take them when you are going home immediately and can get them into a refrigerator. The last thing a person with cancer needs is food borne illness. There are several situations in which restaurant eating is not advised. If an individual is neutropenic (has a very low white blood cell count), and is prone to infections, it is best to eat at home. That way you can make sure the food has the lowest possible bacteria count. In addition, you are avoiding large groups of people and the potential to exposure to their germs. If a eutropenic individual has to eat in a restaurant, they should not order any raw foods such as salad bar, sushi or rare meat. If the restaurant is willing to open a fresh small can of tuna or serve a bowl of boxed cereal, it would be safer to eat than anything that has been pre-prepared and may have been exposed to bacteria. Try to order food that minimizes the risk of bacteria. For example, if the person wants fruit, an unpeeled banana or whole melon (that can then be peeled or cut with a clean knife) is a better choice than a fruit salad that may contain fruit that is harder to wash or was handled. Hot foods should be served hot and cold foods cold, so you know it has not been sitting in the kitchen at room temperature. Bacteria grow rapidly at room temperature. Once the food is served, however, make sure hot food cools down before it is eaten, as you don't want to further damage the mouth or esophagus. If an individual wants to eat out but is having problems with food aversions due to smell, ordering cold food will decrease exposure to smells. Those at the table may have to do the same or avoid whatever bothers the person (Example: the smell of coffee) to help avoid nausea while eating. While that might seem like an inconvenience, the mental boost of companionship during eating and the variety of food a restaurant provides often results in boosting food intake. Dr. Irene